Knee Pain Treatments in Modern Medicine: A Scatter Gun Shot in The Dark. Evidence Up to 2022

A plethora of modalities have been tried for knee pain relief. However, there is no consensus on whether one modality is superior than the other and which treatments should be offered over others and in what order (Corey Huter et al, 2022).

The 2022 ASPN guidelines (Corey Huter et al, 2022) and other recent systematic reviews provided us a most up-to-date picture as shown below.

• NSAIDs

With limited efficacy, all NSAIDs are associated with increased risk of digestive disorders, kidney injury, easy bruising or bleeding and others.

• Antidepressants and Neuroleptics

There is little evidence supporting their efficacy.

• Antihypertensives

There is insufficient evidence to make any recommendations

• Excercise/Education

Very low evidence supporting its efficacy (Sasaki R et al, 2022)

• Multimodal Physiotherapy (MPT) for CRPS Knee Pain

There is no evidence to support MPT's efficacy for CRPS. Injury-induced knee pain is known as Complex Regional Pain Syndrome of Knee (CRPS).

• Electrotherapy for CRPS

Its efficacy for CRPS is unclear.

• Manual lymphatic drainage

Its efficacy for CRPS is absent.

• Physiotherapy for Soft Tissue Injuries

There is no high-quality evidence supporting the use of PT to manage soft tissue injuries of knee.

• Physiotherapy for Patellofemoral Pain Syndrome (PFPS)

There was only anecdotal evidence that facility-based PT programs can potentially benefit patients with PFPS.

• Physiotherapy for Post-Surgical Knee Pain (PSKP)

No data available indicating an effective intervention.

• Taping

There was only low quality of evidence supporting its efficacy.

• Bracing

Braces are cumbersome and uncomfortable, shoe inserts require bigger bulkier and less stylish shoes, do not significantly impact the laxity in the knee joint nor have a significant impact on pain reduction.

• Prophylactic Braces

There is insufficient evidence to support their use.

• Bracing after ACL Reconstruction

No significant difference between the bracing and non-bracing group.

• Cane, Crutch & Walker

The optimal modality remains unclear, and long‐term implications are still to be determined.

• Corticosteroid Injections

May provide short-term weak to moderate pain relief but is associated with an increase in cartilage volume loss.

• Hyaluronic Acid

Evidence is conflicting for the treatment of OA knee.

• Platelet-Rich Plasma (PRP)

There was moderate evidence showing PRP as effective as hyaluronic acid for knee pain secondary to osteoarthritis.

• Mesenchymal Stem Cells

There is moderate evidence supporting the use of MSCs for treatment of knee osteoarthritis. However, there is insufficient evidence for ideal treatment paradigms and generalizability at this time.

• Amniotic Tissue

Moderate evidence for knee pain secondary to OA.

• Genicular Nerve Ablations

There is no high-level evidence to support its use for knee pain

• Peripheral Nerve Stimulation (PNS)

There are limited data to support its use currently (Ilfeld BM et al. 2017).

A Scattergun Shot in The Dark

With such a wide variety of modalities for knee pain management, the 2022 ASPN guide lines pointed out:

• All these modalities are just palliative treatments as a means of prolonging or avoiding the need for surgical intervention,
• There is no consistency or clear agreement on which treatments should be provided at the various stages in the patient journey.

So, all we can do is blindly firing shots in the dark with a scatter gun, they pray.

Patients' Final Destination

In other words, there is no permanent cure available for knee pain. The final destination of a knee pain patient is expected to be nothing but to have their “flesh and bones” knee joint replaced with metal screws.

But You Can Knock out Knee Pain in A Breeze

If you have learned a 2000 years old acupuncture, relieving or erasing knee pain, actually any pain, is just a breeze.

References

Brook Cheng, Knee Pain Instant Relief: An Evidence-Based Therapy You Can't Fail, 2023

https://www.dhirubhai.net/pulse/relieve-knee-pain-instantly-upon-needle-insertion-you-brook-cheng

Corey W Hunter et al, Consensus Guidelines on ... Knee Pain. Journal of Pain Research , 2022